Design: A retrospective cohort study conducted at a tertiary-care institution from 2020-2022. Black women with fibroids who underwent hysterectomy or myomectomy were included in the surgical cohort, which was then categorized by the presence or absence of endometriosis. Women with prior hysterectomy, gynecological malignancies, and those who underwent only hysteroscopic procedures were excluded. The primary outcome was prevalence of concomitant endometriosis in women with fibroids, and secondary outcomes were type of surgery performed (with or without uterine preservation), operative time, intraoperative blood loss, and complication rates. We used the two-proportion Z-test, Wilcoxon rank-sum test, Fisher’s exact test, and a multivariate linear regression analysis to determine whether the presence of endometriosis affects surgical management and complication rates, while controlling for total number of fibroids, largest fibroid size, uterine size, prior cesarean delivery, and BMI.

Setting: Academic hospital.

Patients or Participants: 453 patients were enrolled in the study, 351 met our inclusion criteria, and 151 underwent an eligible surgery and were included in the surgical cohorts.

Interventions: N/A.

Measurements and Main Results: The prevalence of endometriosis in Black women with known fibroids was 20.5%, compared to the baseline population prevalence of endometriosis of 10% (p=<0.00001). In women who underwent surgical management, there was no difference in proportion of uterine-sparing procedures (p=0.342), operative time (p=0.393), intraoperative blood loss (p=0.264), or complication rate (p=0.637).

Conclusion: The prevalence of endometriosis in Black women with fibroids is significantly higher than the general population, despite Black women being less frequently diagnosed with endometriosis. However, the presence of concomitant endometriosis was not associated with a difference in surgical management or post-operative outcomes.